Leadership Conference - Research Abstract: Patients Who Do Not Wait, A Chicago Hospital Perspective

Purpose: Left Without Being Seen (LWBS) patients have been associated with increased emergency department (ED) volumes and long wait times for care. As a result, this patient population may be suffering adverse medical consequences. This study will benchmark the LWBS patients, their acuity and medical outcome in a Chicago hospital ED. This study aims to provide insights and recommendations regarding quality improvement on patient safety issues and improvements in allocation of resources and manpower in the ED to reduce the numbers of patients who leave without being seen by a physician. This study is also important in terms of risk management because adverse outcomes for these patients can constitute a potential medico legal risk for the institution and therefore warrants attention.

Design: Descriptive statistics will be used to analyze and interpret the data.

Setting: The study site is a Level II ED at an academic medical center in Chicago consisting of 34 beds serving an average 40,774 patients per year.

Participants: All patients who registered in the ED but left without being seen by a physician from March 2009 to September 2009 will be selected for the study. As part of the inclusion criteria patients selected for this study had to be able to speak English and follow instructions.

Methods: Participants were contacted by a RN or a nursing student within 48 hours of their registration event and asked to participate in a telephone survey. After verbal consent, participants were asked questions regarding their reasons for leaving the ED prior to medical assessment by a physician, their initial complaints and triage acuity at the time of presentation as well the medical outcome of leaving the ED.

Results: To date approximately one third of the data has been acquired (n=37). 80.6% of participants had an acuity level 3 and 19.4% had an acuity level 4. Participants often left for more than one reason. A majority of the participants, 59.5%, left because the ED appeared very busy, 45.9% left because they were tired of waiting, 13.5% left because they felt their problem could wait and 40.5% left for other reasons. After registering 32.4% of participants waited for 1-2 hours, 21.6% waited for 3-4 hours, 18.9% waited for 2-3 hours, 10.8% waited for less than 30 minutes, 8.1% waited for 1/2 to 1 hour, 5.4% waited for more than 4 hours and 2.7% waited for 5 hours.

Implications: Direction of future research should focus on how to reduce adverse and negative medical outcomes with patients who leave the ED without being seen by a physician. Possible interventions include, addressing hospital protocol, staffing and overcrowding. Quality improvements such as improved patient education in triage procedure; dedicated staff for high acuity patients and comfort measures, such as ice or analgesics, for those waiting to be seen are also possible avenues of investigation.

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Value

Language

dc.type

Presentation

en_GB

dc.title

Patients Who do not Wait, A Chicago Hospital Perspective

en_GB

dc.identifier.uri

http://hdl.handle.net/10755/162567

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dc.description.abstract

<table><tr><td colspan="2" class="item-title">Patients Who do not Wait, A Chicago Hospital Perspective</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2010</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Gonzaga, Marites, MSN, CCNS, CEN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Rush University Medical Center</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Clinical Nurse Specialist</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">1653 W. Congress Parkway, Chicago, IL, 60612, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">312-942-5307</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">marites_b_gonzaga@rush.edu</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Jessica Simeone, BS; Marcia Phillips, RN, PhD</td></tr><tr><td colspan="2" class="item-abstract">Leadership Conference - Research Abstract: Patients Who Do Not Wait, A Chicago Hospital Perspective<br/><br/>Purpose: Left Without Being Seen (LWBS) patients have been associated with increased emergency department (ED) volumes and long wait times for care. As a result, this patient population may be suffering adverse medical consequences. This study will benchmark the LWBS patients, their acuity and medical outcome in a Chicago hospital ED. This study aims to provide insights and recommendations regarding quality improvement on patient safety issues and improvements in allocation of resources and manpower in the ED to reduce the numbers of patients who leave without being seen by a physician. This study is also important in terms of risk management because adverse outcomes for these patients can constitute a potential medico legal risk for the institution and therefore warrants attention.<br/><br/>Design: Descriptive statistics will be used to analyze and interpret the data. <br/><br/>Setting: The study site is a Level II ED at an academic medical center in Chicago consisting of 34 beds serving an average 40,774 patients per year.<br/><br/>Participants: All patients who registered in the ED but left without being seen by a physician from March 2009 to September 2009 will be selected for the study. As part of the inclusion criteria patients selected for this study had to be able to speak English and follow instructions. <br/><br/>Methods: Participants were contacted by a RN or a nursing student within 48 hours of their registration event and asked to participate in a telephone survey. After verbal consent, participants were asked questions regarding their reasons for leaving the ED prior to medical assessment by a physician, their initial complaints and triage acuity at the time of presentation as well the medical outcome of leaving the ED. <br/><br/>Results: To date approximately one third of the data has been acquired (n=37). 80.6% of participants had an acuity level 3 and 19.4% had an acuity level 4. Participants often left for more than one reason. A majority of the participants, 59.5%, left because the ED appeared very busy, 45.9% left because they were tired of waiting, 13.5% left because they felt their problem could wait and 40.5% left for other reasons. After registering 32.4% of participants waited for 1-2 hours, 21.6% waited for 3-4 hours, 18.9% waited for 2-3 hours, 10.8% waited for less than 30 minutes, 8.1% waited for 1/2 to 1 hour, 5.4% waited for more than 4 hours and 2.7% waited for 5 hours.<br/><br/>Implications: Direction of future research should focus on how to reduce adverse and negative medical outcomes with patients who leave the ED without being seen by a physician. Possible interventions include, addressing hospital protocol, staffing and overcrowding. Quality improvements such as improved patient education in triage procedure; dedicated staff for high acuity patients and comfort measures, such as ice or analgesics, for those waiting to be seen are also possible avenues of investigation.<br/><br/></td></tr></table>

en_GB

dc.date.available

2011-10-27T10:30:22Z

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dc.date.issued

2011-10-17

en_GB

dc.date.accessioned

2011-10-27T10:30:22Z

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dc.description.sponsorship

Emergency Nurses Association

en_GB

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